From new oral GLP-1s to emerging biosimilars and fast-moving policy proposals, 2026 has already begun to show meaningful dynamics likely to impact the entire pharmacy benefits landscape. Here are the five trends we believe will be most important for plan sponsors to monitor and address in 2026.
1. GLP-1s in 2026: Access expands while spend concentrates
Oral options, label expansions, and new drug classes are broadening access to GLP-1 therapy even as costs cluster where coverage remains open. For plan sponsors, this means 2026 will involve a number of GLP-1 coverage decisions and conversations about potential pricing shifts with your PBM.
In early January, the first oral Wegovy® formulation entered the market, with the highest oral dose performing similarly to the highest dose of injectable Wegovy in clinical studies.
Pricing (as of January 2026) reflects an annual therapy cost just over $16,000 for Wegovy, with cash offers on Novo Nordisk’s platform ranging from approximately $149 to $299 per month depending on dose and timing of a limited-time offer. Looking ahead, Eli Lilly’s own oral GLP-1 formulated product, orforglipron, may receive FDA approval as early as Q1 2026.
Beyond oral agents, it will be important to watch for expanding indications for GLP-1s, such as potential MACE risk-reduction, MASH-related liver disease applications, and obesity-related heart conditions.
An analysis of Truveris book of business data showed that coverage for weight-loss GLP-1s peaked in 2024 and tightened in 2025 as plans added guardrails such as prior authorization and step therapy, yet average spend per covered contract rose sharply, from about $1.0M in 2023 to more than $2.1M in 2025.
In 2025, 27% of Truveris client PBM contracts still covered weight-loss GLP-1s.
2. Biosimilars: From early adoption to standard formulary strategy
Plans should be looking towards potential formulary changes that include biosimilar options to manage high-impact and high-cost drugs. Expected price differentials between biosimilars and reference biologics (sometimes up to 50%) and evolving FDA guidance are creating meaningful savings opportunities, but can also create more complex patient transitions.
Truveris’ 2024-2025 book of business analyses tracked the Humira biosimilar launch and saw usage accelerate in 2024, reaching ~19% adoption. By 2025, biosimilars nearly matched reference Humira (48% of claims vs. 52%) while reference Humira spend dropped by ~52%.
Average per-claim costs were calculated to be ~$3,870 for biosimilars versus ~$9,080 for the reference product. Early Stelara biosimilar adoption reached roughly 25–30% in 2025, and we expect a similar cost-reducing trajectory over time.
3. Policy watch: National and state PBM & drug pricing policies
Most Favored Nation (MFN) pricing and “TrumpRx”
Announced in September of 2025, Most Favored Nation (MFN) policies are intended to narrow price gaps between the US and other developed nations. As of February 5, 2026, the Trump administration has launched TrumpRx, a direct-to-consumer platform that references MFN pricing. TrumpRx directs consumers to drug purchasing options and discount programs and aggregates discounted cash pay offers through manufacturer and partner platforms. Behind the scenes, it leverages existing industry infrastructure like GoodRx to power pricing and coupon flows, bringing these MFN-aligned cash pay options together under a single federal portal. To learn more about TrumpRx, visit our blog “TrumpRx Launch Details.”
The Great Healthcare Plan
Initially announced as a policy framework, the Plan outlines high-level goals to lower drug prices and premiums, hold insurers accountable, and maximize price transparency. Early concepts include directing subsidy dollars to members, new provider disclosure requirements (revenue, care costs, and claim stats), and eliminating PBM rebate “kickbacks” in favor of passing rebates back to plans, though more details are needed to understand how these goals may be implemented.
Centers for Medicare & Medicaid Services (CMS) Pricing
Maximum Fair Prices (MFPs) for the first set of high-cost Part D drugs took effect January 1, 2026, with reductions estimated in the 25–60% range for Medicare plans. Employers should expect smaller rebate pools on affected drugs and watch for either upward commercial price pressure to offset lost Medicare revenue, or downward pressure as MFPs reset reference points.
PBM reform at the federal and state level
On February 3, 2026, President Trump signs the Consolidated Appropriations Act (CAA) of 2026 into law, and while the CAA covers a wide range of federal priorities, it includes the advancement of long awaited PBM reform. The new laws require PBM pass-through of 100% of rebates, transparent PBM reporting, and audit authorities, among others. For a deeper dive on these new laws, visit our blog “Federal PBM Reform Arrives.”
At the state level, recent activity includes Iowa (SF 383) mandating 100% rebate pass-through and banning spread pricing; California (SB 41) banning spread pricing and requiring transparent pricing; Colorado (HB25-1094) delinking PBM compensation from drug price; and Arkansas (HB 1150) restricting PBM ownership of pharmacies to reduce conflicts.
4. Direct-to-consumer (DTC) drug purchasing: Lower prices, new trade-offs
Recently, several pharmaceutical manufacturers including Novo Nordisk and Eli Lilly have introduced direct-to-consumer purchasing programs (Novocare and LillyDirect, respectively). Instead of buying medications at the pharmacy using their insurance, patients can go to the manufacturer website directly and get exclusive discounts for their prescribed medications, simplifying the member experience and offering transparent pricing
There are several considerations for plan sponsors as this new purchasing behavior may have a big impact on commercial plans and PBM contracts:
- These programs will pull claims data away from the pharmacy benefit. With lower utilization, this could cause PBM pricing changes and a potential revision of PBM/pharma manufacturer pricing negotiations.
- Members who use these programs will not have these costs applied to their deductible or OOP maximum, meaning they could end up paying more for other healthcare related services or prescriptions.
- There may be fewer clinical and safety protections that are typically standard for medications that go through the pharmacy benefit.
It will be important for plans to establish clear member communication strategies and to monitor claims data to understand how plan visibility might be affected by these new purchasing behaviors.
5. 2026 drug pipeline and patent exclusivity
A significant wave of new specialty, brand, and gene therapies is expected in 2026. GLP-1s remain a headline category, with potential new approvals and indication expansions.
In oncology and rare diseases, smaller populations but high cost per treatment will continue to create outsized financial impacts, and gene therapy approvals could reach up to six in 2026. While these are one-time treatments, gene therapy price tags often exceed several million dollars.
On the other side of the cost spectrum, several brand medications are slated to lose patent exclusivity in 2026, including the Januvia® family (diabetes), Tradjenta® and Jentadueto® (diabetes), and the Xeljanz® family (inflammatory conditions).
Key takeaways
Pharmacy plans will be impacted by several converging dynamics in 2026: new therapies, shifting policies, and evolving market and member behaviors.
Given this uncertainty, plan sponsors should take a proactive stance through initial forecasting and aligning their clinical coverage policies with at-risk areas of their contract. Regular claims monitoring and utilization review can help guide towards expected performance milestones and uncover any major shifts in spend or member challenges.
We recommend keeping an open line of communication with your PBM and asking tough questions early so you’re prepared to make educated contracting decisions.
Truveris is a pharmacy cost containment company dedicated to reducing pharmacy costs and driving transparency for employers and benefit consultants. Our proprietary, data-driven technology and deep industry expertise empower smarter pharmacy benefit decisions through contract optimization and PBM oversight. Independent and unbiased, Truveris delivers measurable savings and accountability across every pharmacy program.
